MEDICARE: CINCINNATI ORIENTAL MEDICINE CLINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1912671363
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CINCINNATI ORIENTAL MEDICINE CLINIC

Provider Business Mailing Address
First Line	:	3893 LOST WILLOW DR
Second Line	:
City	:	MASON
State	:	OH
Zip	:	45040-4758
Country	:	US
Telephone Number	:	513-884-0097
Fax Number	:	888-847-1235

Provider Business Practice Location Address
First Line	:	8583 UNIT 5 MASON-MONTGOMERY RD
Second Line	:
City	:	MASON
State	:	OH
Zip	:	45040-9339
Country	:	US
Telephone Number	:	513-884-0097
Fax Number	:

Authorized Official
Title or Position	:	OWNER/ACUPUNCTURIST
Name	:	XIAOFEI SHANGGUAN
Credential	:
Telephone Number	:	513-884-0097

Provider Enumeration Date	:	08/08/2021
Last Update Date	:	08/08/2021

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Directions to “CINCINNATI ORIENTAL MEDICINE CLINIC ” Practice Location

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